1C GRISWOLD DR - BUILDING INSPECTION EPPrOFSXLEn
r PUBLIC PROPERTY
DEPARTMENT
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A_pPLtCATION FOR THE Rt pA_M RENOVATION cnNQmw TinN-
DEKOL IW&OR CHANGE OF USE OR OCCIMANcy_ anon Arty trra[i=W
STRUCTURE OR BUIL.DIING
1.0 SITE INFORMATION
Location Narnw. l SuNow
Property is to ated Ina:CanervaVan Ame WN HNlorb ftllfld YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Nae+e: ,
Addrosc
Telephone: 9 7 e—977—` V 'f
7ACOMPLETE THIS SECTION FOR WORK IN El<ISLlIQ BUILDINGS ONLY
Addition Existing
Renovation Number of Storiee Renovated
Change In Use y New
DemoGtlan Existing
Approximate year of Area per flow(sQ RenavalWedconstruction or renovation
of existing building
add Description of Proposed Work:
--- -- ---Mail Permit to: - - -
W hd Is the ou"m use of the Sudd ft? if dwe&,&how many units? -
MatwW of DuldkV Asbestos?
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ArahROWS Me" P.O. Bo
Peabody, MA 01960 ( 1
Addrew and Pha» _
LAedwdes Nana
Address and Phone HIC Rapiskstion S
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Es*natsd Cad of Project Pannr FM Calwlallon
PomR Fee: - Estimated Coat X$741000 ReskW"
Es*natad Coat X i11/i1000 CammwcML
An AddNkww$5.00 Is added a•an
Adminmrove dwjpL
Make sun that al Raids are ProWV and wW*written to avoid delep In Desna
The undersigned doe•hereby apply for a eundit Pere*to tw the above stated
speeiAeatlona. Signed under penafiy of PwNW
Date �7
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